Durhane Wong-Rieger, President & CEO,Canadian Organization for Rare Disorder (Apr 24, 2020 )

1. APPLYING LESSONS
FROM COVID-19
TO BETTER
HEALTHCARE FOR
RARE DISEASES
DURHANE WONG-RIEGER, Ph.D
PRESIDENT & CEO
APRIL 24, 2020

2. The Canadian Organization for Rare Disorders joins with all Canadians in the fight against COVID-19. But
for Canadians with chronic conditions, rare and common, the fight against their disease has become even
more challenging. Patients with underlying conditions that compromise the immune, respiratory, and
cardiac systems, are more susceptible to COVID-19 and its complications. In early April CORD sent out a
survey asking the impact of COVID-19 on rare disease patients and families. Approximately, 300 responses
have been received.
INTRODUCTION

3. 3/4 felt they were at “great” or “very great” risk for COVID-19 complications
“My daughter gets every virus and takes longer to recover.”
“…repeat serious double lung antibiotic resistant pneumonia history, asthma, auto immune condition,
and recent bad flu symptoms further physically weakening.”
2/3 said they were “somewhat” to “very” concerned about seeking healthcare because of fear of
exposure to COVID-19
“I've been told should I contract COVID-19 I would be low on the list for treatment due to shortage and
survival of the fittest.”
“Afraid to go to appointments in hospital. Deferring appointments.”
RISK OF COVID-19

4. 1/2 reported difficulty receiving medical care, e.g. delayed or cancelled surgeries, bloodwork, dialysis,
and physiotherapy.
“The surgery that is not happening would resolve a problem, in the meantime I am not functional and
am bedridden and in a lot of pain.”
“I need medical follow up because of serious post op complications and about 75% of it is not
happening.” “Specialist in a different city.”
Fear will lack services when needed
“The fear of going into an adrenal crisis during this pandemic.”
“I understand the extra caution and hope no flare ups happen during this pandemic....”
1/2 had difficulty accessing rehabilitation or critical services, including personal support care.
“…had to stop all home supports 4x per day due to risk of infection.”
“House Bound/extreme mobility issues/no one able to help because of mine and their fears/stay at
home in effect.”
IMPACT OF COVID-19 ON ACCESS TO CARE

5. 40% experience “some” to “great” difficulty getting access to medicines
Regular medicines (amoxicillin, hydroxyurea) were not available; could only get a portion of their regular
supply; receive a substitute
“The medication I require is now needed to treat COVID - I won't get treatment I need because I agree
the health care professionals do need it first - it's going to be a long 24+ months.”
Most barriers not shortage but logistics (computer crashed because of demand); lack of local supply (had
to call four pharmacies, backorder); and safety concerns
“Daughter needed a right heart cath[erization] … to be able to move to a new medication. The heart
cath[erization] was cancelled the Wednesday before.”
“I was told my prescription may be terminated on April 16 as they are trying to free up
Hydroxychloroquine for research into the virus. I was told they [pharmacists] have never heard of my
disease.”
System delays e.g. cancellation of clinical trial, delayed Health Canada approval for a Special Access
Program request, and inability to access bloodwork to qualify for therapy.
IMPACT OF COVID-19 ON ACCESS TO MEDICATION

6. 3/4 of experienced “some” to “great” anxiety, fear or stress because of COVID-19 and one-half had
withdrawn emotionally
“I am anxious my lack of follow-up will result in serious problems or that I'll get COVID and probably die
if I go to the hospital.”
“very high stress, parent of 4 children, two of whom have specialized needs, panic attacks, deeply struck
with grief and anxiety on daily basis.”
IMPACT OF COVID-19 ON MENTAL HEALTH

7. • Access to their healthcare provider through phone or email
• Use telehealth
• Referral to an off-site blood lab and follow up with team by telephone
• Lab worker came to the house to draw blood
• Care team “went ahead and started a life-extending new medicine without the normal pre-requisite
heart catherization.”
POSITIVE HEALTHCARE PROVIDER RESPONSES

8. Survey sent to the pharmaceutical suppliers of rare disease medicines
• Most Canadian drug supplies not in jeopardy
• Taking steps to assure procurement, production, and delivery to meet future needs
• Making alternative arrangements for drug administration (for example, at specialty pharmacy sites)
or supporting home administration
• On-going clinical trials not interrupted, with alternative arrangements for administration, monitoring
and follow-up data collection if necessary
PHARMACEUTICAL INDUSTRY RESPONSE

9. NEXT STEPS
CORD will:
• Create a summary report for dissemination and advocacy
• Write to Health Ministers to advise of rare disease community impact and concerns and how these will
be addressed in parallel
• Propose Working Group on care for chronic disease and other patients during crisis, especially in
preparation for next waves (and next crisis)

10. 32PERCENT
2 Rare disease is a distinct medical speciality. Like oncology, cardiology, neurology, endocrinology, and
pediatrics, rare disease needs comprehensive specialty centres networked to localized practitioners and
community-based services.
1 You gotta have a plan. Every rare disease patient needs to have an individualized plan developed in
consultation with the patient and family and readily available (in electronic form), to all providing
healthcare services, especially in emergency situations.
3 Deal with the crisis, but don’t sacrifice those with other healthcare needs. Set up a team to identify,
prioritize, triage, and alternatively resolve the needs of those with chronic and other healthcare conditions.
4
Canada needs an innovative pharmaceutical industry. Companies in Canada are stepping up to assure
adequate supplies of emergency drugs and medical devices and are partnering with researchers to develop
new tests, therapies, and vaccines for COVID-19. At the same time, they are ensuring that Canadians with
rare and common conditions have continued access to the drugs, tests, and other technologies needed.
Perhaps this is the opportunity to develop truly effective public-private partnerships.
BIG LEARNING FROM FEEDBACK ON COVID-19 IMPACT ON RARE DISEASE
CORD strongly supports actions in fight against COVID-19.
Equally vital not neglect essential care and treatment for
patients with existing health conditions.

12. MAY
06
APRIL
29
MAY
13
Patients Speak Out
at noon at noon at noon
Rx
FEDERAL PRICE CONTROLS AND ACCESS
TO MEDICINES WEBINAR SERIES
Drug Launches: What Influences
the Decision to Deploy New Medicines?
Alternative Approaches to
Innovative Drug Pricing